Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea.
Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Mov Disord. 2019 May;34(5):727-734. doi: 10.1002/mds.27637. Epub 2019 Feb 13.
Following the emergence of magnetic resonance-guided focused ultrasound as a promising tool for movement disorder surgery, thalamotomy for essential tremor using this technique has become a useful tool based on its efficacy and lack of adverse effects. Here, we summarize the 4-year results of previous reports focusing on the durability of effectiveness of magnetic resonance-guided focused ultrasound thalamotomy for essential tremor.
From October 2013 to August 2014, 15 patients with intractable essential tremor were enrolled. Twelve of them completed clinical assessment through 4 years of postoperative follow-up. Tremor severity, task performance, and disability were measured using the Clinical Rating Scale of Tremor.
The mean age of the 12 patients was 61.7 ± 8.1 years. Maximally delivered energy was 15,552.4 ± 6574.1 joules. The mean number of sonications was 17.3 ± 1.6. The mean postoperative lesion volume was 82.6 ± 29.023 mm and in 1 year was a mean of 9.667 ± 8.573 mm . Four years postoperatively, improvement of the hand tremor score was 56%, that of the disability score was 63%, that of the postural score was 70%, and that of the action score was 63% compared with baseline; all improvements were significant and sustained over the 4-year period after thalamotomy. There was no permanent adverse effect throughout the 4-year follow-up period.
Magnetic resonance-guided focused ultrasound thalamotomy exhibits sustained clinical efficacy 4 years after the treatment of intractable essential tremor. Adverse events are generally transient. A large cohort of patients who have undergone magnetic resonance-guided focused ultrasound thalamotomy with longer follow-up is needed to confirm our findings. © 2019 International Parkinson and Movement Disorder Society.
随着磁共振引导聚焦超声作为一种有前途的运动障碍手术工具的出现，使用该技术进行丘脑切开术治疗原发性震颤已成为一种有效的治疗方法，且无不良反应。在此，我们总结了既往研究报告中使用磁共振引导聚焦超声治疗原发性震颤的 4 年结果，重点关注其疗效的持久性。
2013 年 10 月至 2014 年 8 月，共纳入 15 例药物难治性原发性震颤患者。其中 12 例完成了 4 年的术后随访，进行了临床评估。使用震颤临床评分量表（Clinical Rating Scale of Tremor）测量震颤严重程度、任务表现和残疾程度。
12 例患者的平均年龄为 61.7 ± 8.1 岁。最大能量输出为 15552.4 ± 6574.1 焦耳。超声次数平均为 17.3 ± 1.6 次。术后平均病灶体积为 82.6 ± 29.023 毫米，术后 1 年为 9.667 ± 8.573 毫米。术后 4 年，手部震颤评分改善 56%，残疾评分改善 63%，姿势评分改善 70%，动作评分改善 63%，与基线相比均有显著改善且持续 4 年。在丘脑切开术治疗后 4 年的随访期间，没有出现永久性不良反应。
磁共振引导聚焦超声丘脑切开术治疗药物难治性原发性震颤 4 年后仍具有持续的临床疗效。不良事件通常是短暂的。需要更大的、接受磁共振引导聚焦超声丘脑切开术的患者队列和更长的随访时间来证实我们的研究结果。© 2019 国际帕金森病和运动障碍协会。
